The National Committee for Quality Assurance has given health plans a compelling reason to set up external-appeals processes for members who have exhausted internal avenues for redress. Beginning next year, HMOs seeking accreditation must have a third-party reviewer — an independent, NCQA-approved organization — in place.
In the wake of expensive jury verdicts and under a threat of federal legislation, many health plans — worried that their liability shield, the Employee Retirement Income Security Act of 1974, is rusting away — have voluntarily established third-party review. In late February, the American Association of Health Plans urged its member health plans to adopt external-appeals processes.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.